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Surgical Options for Breast Cancer

Posted by Allison DiPasquale, MD on Jun 1, 2016 2:44:28 PM

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In my earlier blog, Genetics and Breast Cancer: What You Need to Know, we touched on surgical options for breast cancer. This blog goes into more detail.

The type of surgery you have depends on the type of mutation, the type of cancer, and the extent of disease.

BRCA1 and BRCA2

BRCA mutations are usually aggressive, and patients who have a BRCA mutation are at greater risk for cancer in the noncancerous breast, ovarian cancer, as well as other forms of cancer.

These are the surgical options that I discuss with patients:

  • Removal of both breasts — including the noncancerous breast — and breast-reconstruction surgery.
  • Removal of only the cancerous breast and breast-reconstruction surgery.
  • Breast conservation surgery (also called a lumpectomy). With this option, the patient would undergo high-risk monitoring (explained below), which is an effective way to catch a return of the cancer in an early stage when it’s curable.
  • Removal or ablation of the ovaries. Since there is no reliable screening for finding ovarian cancer in an early stage, I recommend surgically removing or ablating the ovaries after the patient is finished having children. (Ovarian ablation stops the ovaries from producing estrogen and lowers estrogen levels in the body.)

Other genes

With other genetic mutations, there is no data that shows that removal of the cancerous breast will help patients live longer, and the benefit of removing the noncancerous breast is low. These patients often choose breast-conservation surgery with high-risk monitoring.

Of course if patients have a lot of anxiety about the cancer returning, they can choose to remove one or both breasts. It’s always their choice.

No known genetic link

Patients who test negative for any genetic link to breast cancer can talk to their doctor about breast-conservation surgery with high-risk monitoring or removal of the cancerous breast.

High-risk monitoring

With high-risk monitoring, also called high-risk surveillance, patients undergo an imaging scan every six months, alternating between a mammogram and an MRI scan.  

MRI is the most sensitive test for examining the breast and the best way to screen for breast cancer. The views are so detailed, that in fact, it can give false positives, which are growths that are shown to be benign after a biopsy.

In addition, the patient would have a clinical breast exam by her breast surgeon or gynecologist at least twice a year.

With the combination of six-month scans plus the exams, tumors would be detected in the earliest stages when it is curable.

Breast cancer treatment at Methodist Charlton Medical Center

The Breast Center at Methodist Charlton Medical Center combines a multidisciplinary approach to treating breast cancer with the latest advances in technology.

SAVI Scout® surgical guidance system for enhanced outcomes

Use of this device for locating tumors that are difficult for the surgeon to feel and see has significantly enhanced cosmetic outcomes and improved patients’ comfort. Methodist Charlton is one of the few centers in Dallas to use the SAVI Scout® surgical guidance system.

Before SAVI Scout, patients underwent an uncomfortable procedure on the day of surgery, where a radiologist would use mammography to locate the tumor, and then insert a wire that led to it. While this method worked, it was problematic.

  • Patients had to arrive three hours before surgery for the procedure.
  • The procedure was painful — the wire was placed while under mammogram.
  • Radiologists placed the wire, and they typically don’t know where I would like to make the incision to hide and minimize scars.
  • Because the mammogram only shows two views of the tumor, radiologists had few options for placing the wire, which in turn limited my options for incisions.

With SAVI Scout, marking the tumor is easier on the patient, gives me more options for incisions, and produces a much better cosmetic result:

  • Up to a week before surgery, a radiologist uses advanced ultrasound to insert a reflector using a small needle. This procedure is much more convenient and comfortable.
  • During surgery, I use a probe that indicates the precise location of the tumor.
  • I then make the incision anywhere I want — I’ll take the extra time to fully explore the best place to make an incision that I can hide. This is essential for minimizing the appearance of scars and optimizing the patient’s cosmetic results.
  • The infrared reflector — which is not radioactive or a radioactive seed — doesn’t interfere with sentinel lymph node biopsy.

Accredited imaging center

The Breast Center at Methodist Charlton has received a three-year, full accreditation from the National Accreditation Program for Breast Centers (NAPBC), for its commitment to offer patients every significant advantage in their battle against breast cancer and breast disease.

It is also designated a Breast Imaging Center of Excellence by the American College of Radiology (ACR), the ACR’s voluntary breast imaging accreditation programs and modules, in addition to the mandatory Mammography Accreditation Program.                                                                                                                                           

One location for everything

The Breast Center is a one-stop shop, so to speak, where patients receive treatment in a centralized location rather than having to travel across the city to different appointments. They can see all their physicians — surgeon, medical oncologist, radiation oncologist, and other specialists; have imaging tests; undergo procedures; and meet with the oncology nurse navigator all in the same place.

Multidisciplinary tumor boards

Patients benefit from a meeting of all the great minds involved in their care —pathologists, radiologists, surgeons, medical oncologists, and radiation oncologists — and as a result receive treatment that is of the highest quality.

Genetic counseling, before and after testing

(use the shorter version here)

Patients meet with the genetic physician before testing so they understand what each genetic mutation means. Testing positive for a particular mutation impacts the type of surgery patients will have.

Oncology nurse navigator

The oncology nurse navigator offers patients and their families support from the time they are diagnosed with breast cancer through recovery and beyond. As soon as patients are diagnosed with breast cancer, the navigator contacts them to offer information and support, often accompanying them to their doctor appointments. She also coordinates all of the patients’ consultations, tests, and procedures; makes sure they and their families receive the support, guidance, and resources they need; and serves as a central point of contact for questions or anything they may need.

Methodist Charlton Breast Center

Texas law prohibits hospitals from practicing medicine. The physicians on the Methodist Health System medical staff are independent practitioners who are not employees or agents of Methodist Health System.


DiPasquale.pngDr. DiPasquale is dedicated to the treatment and cure of breast cancer. Her commitment is personal having experienced her own family members being affected by the disease. As a result, she sought fellowship training to specialize in breast surgical oncology and practices oncoplastic reconstruction of the breast to leave both the patient and the breast with minimal reminders of cancer. Dr. DiPasquale's research interests include triple negative breast cancer, intraoperative radiation, and leading-edge techniques to improve the appearance of the breast after surgery. Dr. DiPasquale is board certified in general surgery. She completed the Surgical Society of Oncology Breast Fellowship at City of Hope National Cancer Center in Duarte, California; her residency in general surgery at Lahey Clinical Hospital in Burlington, Massachusetts, where she was chief resident and chief of curriculum; and her medical degree at St. George’s University School of Medicine.

Topics: Wellness

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